Thyroid incidentalomas

Czech version

Authors: Jan Jiskra
Authors‘ workplace: 3. interní klinika 1. LF UK a VFN, Praha
Published in: Vnitř Lék 2022; 68(7): 465-474
Category: In Brief
doi: https://doi.org/10.36290/vnl.2022.098

Overview

Thyroid nodules are very common. Most of them are benign non-secerning incidentally found nodules – thyroid incidentalomas. Ultrasound (US) is an essential initial diagnostic tool in thyroid nodules management. Based on the US character, thyroid nodules should be classified to one of the US risk categories (TIRADS – Thyroid Imaging Reporting and Data System). Based on the US risk category and size, some nodules should be referred to fine needle aspiration with cytological evaluation of the sample (FNAC), some should be followed just by US, and some require no follow-up. Further management depends on the FNAC (Bethesda category) and US risk category. In most nodules (Bethesda category II, repeatedly Bethesda category I, some of the nodules of Bethesda category III), just defensive management is recommended (US and/or clinical follow-up, or no follow-up). Usually, only few cases require diagnostic (Bethesda categories III, IV and V) or therapeutic (Bethesda V and VI) surgery. In decision-making of management of nodules Bethesda category III and V, molecular testing for mutations associated with thyroid cancer and serum calcitonin could be useful.

Keywords:

thyroid cancer – ultrasound – molecular testing – thyroid nodule – TIRADS – fine needle aspiration biopsy – Bethesda classification

Sources

1. Gharib H, Papini E, Paschke R et al. AACE/AME/ETA Task Force on Thyroid Nodules. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules. Endocr Pract. 2010 May‑Jun;16(Suppl1):1-43.

2. Ahn HS, Kim HJ, Welch HG. Korea’s thyroid‑cancer „epidemic“-- screening and overdiagnosis. N Engl J Med. 2014 Nov 6;371(19):1765-7.

3. Welch HG, Kramer BS, Black WC. Epidemiologic Signatures in Cancer. N Engl J Med. 2019 Oct 3;381(14):1378-1386.

4. Ito Y, Miyauchi A, Kihara M, Higashiyama T et al. Patient age is significantly related to the progression of papillary microcarcinoma of the thyroid under observation. Thyroid. 2014 Jan;24(1):27-34.

5. Haugen BR, Alexander EK, Bible KC et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016 Jan;26(1):1-133.

6. Jiskra J. Diagnostika a další péče o pacienty s tyreoidálními uzly: doporučení American Thyroid Association 2015 modifikované pro podmínky České republiky. Čas. Lék. Čes. 2017;156: 241-251.

7. Smith D, Botz B. ACR Thyroid Imaging Reporting and Data System (ACR TI‑RADS). Reference article, Radiopaedia.org. (accessed on 11 Jun 2022) https://doi.org/10.53347/rID-52374

8. Russ G, Bonnema SJ, Erdogan MF et al. European Thyroid Association Guidelines for Ultrasound Malignancy Risk Stratification of Thyroid Nodules in Adults: The EU‑TIRADS. Eur Thyroid J. 2017 Sep;6(5):225-237.

9. Yang R, Zou X, Zeng H et al. Comparison of Diagnostic Performance of Five Different Ultrasound TI‑RADS Classification Guidelines for Thyroid Nodules. Front Oncol. 2020 Nov 16;10:598225.

10. Singh Ospina N, Maraka S, Espinosa DeYcaza A et al. Diagnostic accuracy of thyroid nodule growth to predict malignancy in thyroid nodules with benign cytology: systematic review and meta‑analysis. Clin Endocrinol (Oxf) 2016; 85:122-131.

11. Boelaert K, Horacek J, Holder RL et al. Serum thyrotropin concentration as a novel predictor of malignancy in thyroid nodules investigated by fine‑needle aspiration. J Clin Endocrinol Metab. 2006;91:4295-301.

12. Gharib H, Papini E, Garber JR et al. AACE/ACE/AME Task Force on Thyroid Nodules. American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules-- 2016 UPDATE. Endocr Pract. 2016;22:622-39.

13. Krátký J, Ježková J, Kosák M et al. Positive Antithyroid Antibodies and Nonsuppressed TSH Are Associated with Thyroid Cancer: A Retrospective Cross‑Sectional Study. Int J Endocrinol. 2018 Sep 6;2018:9793850.

14. Mian C, Perrino M, Colombo C et al. Refining calcium test for the diagnosis of medullary thyroid cancer: cutoffs, procedures, and safety. J Clin Endocrinol Metab. 2014 May;99(5):1656-64.

15. Fugazzola L, Di Stefano M, Censi S et al. Basal and stimulated calcitonin for the diagnosis of medullary thyroid cancer: updated thresholds and safety assessment. J Endocrinol Invest. 2021 Mar;44(3):587-597.

16. Paschke R, Cantara S, Crescenzi A et al. European Thyroid Association Guidelines regarding Thyroid Nodule Molecular Fine‑Needle Aspiration Cytology Diagnostics. Eur Thyroid J. 2017 Jul;6(3):115-129.

17. Hegedüs L, Bonnema SJ, Bennedbaek FN. Management of simple nodular goiter: current status and future perspectives. Endocr Rev. 2003;24:102-32.

18. Lillevang‑Johansen M, Abrahamsen B, Jørgensen HL. Duration of over- and under‑treatment of hypothyroidism is associated with increased cardiovascular risk. Eur J Endocrinol. 2019;180:407-16.

19. Abrahamsen B, Jørgensen HL, Laulund AS et al. The excess risk of major osteoporotic fractures in hypothyroidism is driven by cumulative hyperthyroid as opposed to hypothyroid time: an observational register‑based time‑resolved cohort analysis. J Bone Miner Res. 2015;30:898-905.

20. Brandt F, Thvilum M, Almind D et al. Hyperthyroidism and psychiatric morbidity: evidence from a Danish nationwide register study. Eur J Endocrinol. 2013;170:341-8.